dacryocystorhinostomie

Dacryocystorhinostomie, commonly abbreviated DCR, is a surgical procedure designed to treat obstruction of the nasolacrimal duct by creating a new drainage route between the lacrimal sac and the nasal cavity, bypassing the obstructed segment. The operation is indicated for chronic epiphora with NLDO or recurrent dacryocystitis when less invasive measures have failed.

Two main approaches exist: external DCR and endoscopic endonasal DCR. External DCR involves a skin incision near the medial canthus and direct anastomosis between the lacrimal sac and nasal mucosa, often yielding high long‑term patency but leaving a cosmetic scar. Endonasal DCR uses nasal endoscopy to create the ostium from inside the nose, avoiding external scarring; it requires specialized equipment and expertise, with comparable success rates in experienced hands.

Procedure details typically involve anesthesia (local or general). External DCR creates a bony window between the lacrimal sac and the nasal cavity and sutures mucosa to mucosa to fashion a patent ostium; a silicone lacrimal stent or tube is sometimes inserted across the new passage for several weeks. Endonasal DCR follows similar tissue steps but is performed entirely through the nasal cavity, occasionally with laser or drill-assisted ostium creation and variable stent use.

Outcomes reported in the literature show success rates generally in the 85–95% range for external DCR and roughly 80–95% for endonasal DCR, influenced by patient selection and follow-up duration. Complications may include bleeding, infection, ostium stenosis, canalicular or lacrimal sac injury, synechiae, or stent-related issues. Some patients may require revision DCR or, in canalicular obstruction cases, conjunctivodacryocystorhinostomy.